A recent medical study, published in Cancer Epidemiology, Biomarkers & Prevention on January 9, 2023 showed nearly one in five new cervical cancers diagnosed from 2009-2018 were in women 65 and older.
This is frightening, especially because public health organizations have recommended discontinuing PAP smears for women over 65.
The PAP test, is a simple, non invasive screening test usually done yearly by a GP or Gynecologist in an office check up.
Many of my patients have reported to me that their doctor told them that since they are over 65, they no longer need to have a PAP test. There are many large medical service organizations following this recommendation, such as Kaiser Permanente.
The data they are relying on to make this decision is flawed. I have written about this before, at the time of the study. Apparently what was found and not broadly publicized for some unknown reason was that included in the group of women in the study were women who had a hysterectomy. Women with a hysterectomy usually don’t have a cervix (although there is a type of hysterectomy that preserves the cervix). So obviously none of those women could have cervical cancer. When the study was re-analyzed after removing all of the women with a hysterectomy, the revised results indicated an actual increase in the number of women with cervical cancer over 65, which is exactly consistent with what this new study is reporting.
In addition, the story gets worse.
71% of the women over 65 diagnosed with cervical cancer were in more advanced stages of the cancer compared to 48% of younger women. Five year survival for women over 65 was also significantly lower than that of younger women (23.2%-36.8%) compared to patients under 65 (41.5%-51.5%). Women 80 and older had the worst survival of all.
“Our study found worsening five-year relative survival from cervical cancer with each increasing age category for both early and late-stage diagnoses,” said co- author Theresa Keegan, a professor in the UC Davis Division of Hematology and Oncology.
The PAP test was developed in the 1940’s and instantly had an impact on reducing the number of deaths from cervical cancer because of allowing for very early detection and cure. It became the mainstay of the yearly gynecology “check up.”
However, over the years, there has been an element of complacency over the screening test, and many women become less diligent about the “gyn check up” as they get older, especially after menopause. Unfortunately, this is the age group that is actually more vulnerable and at higher risk of developing a deadly form of cervical cancer, which should be completely preventable with a simple PAP test.
As current screening guidelines have changed, more women over 65 are being neglected in an illness previously proven to be avoidable.
There is also a type of hysterectomy that has become more popular recently where the cervix is retained to be used as “an anchor” for the pelvic floor organs in cases of prolapse. Some of these women don’t realize that with any retained cervical tissue, the risk of cervical cancer still exists. These women still need a PAP screening to prevent this, and sometimes are not informed of this by their physician. I talk to female patients every day who inform me they haven’t had a PAP test in years. When I recommend it to them, I often am told that either their Gyn told them they don’t need it anymore, or they just don’t like doing it.
Believe me when I say, THAT IS A BIG MISTAKE.
I recommend a PAP test yearly for all of my female patients with an intact cervix regardless of their age. And now we have strong data supporting this simple plan.
Please get your PAP done!
All the Best, In Radiant Health,
Howard Liebowitz, M.D.
